THE CLINICAL PICTURE SATVINDER SINGH BAKSHI, MS, DNB Associate Professor, Department of ENT and Head & Neck Surgery, All India Institute of Medical Sciences, Mangalagiri, India

Fissured

43-year-old man presented with a 3-week his- A tory of halitosis. He was also concerned about the irregular appearance of his tongue, which he had noticed over the past 3 years. He had no history of wearing dentures or of any skin disorder. On examination, he had poor oral hygiene and deep fi ssures on his tongue (Figure 1). A diagnosis of fi ssured tongue was made, and the patient was pre- scribed oral chlorhexidine gargles 3 times a day for 1 week. He was reassured of the benign nature of the condition and was educated about the need for good oral hygiene.

■ A BROAD (scrotal tongue, plicated tongue, lin- gua plicata) is a common normal variant of the tongue surface with a male preponderance and a reported prevalence of 10% to 20% in the general population, and the incidence increases strikingly with age.1 The cause is not known, but familial clustering is seen, and a polygenic or autosomal dominant heredi- tary component is presumed.1 The condition may be associated with remov- Figure 1. The fi ssures, present for the past able dentures, , pernicious , 3 years, were asymptomatic. Sjögren syndrome, , acromegaly, macroglos- sia, oral-facial-digital syndrome type I, Pierre Robin clinical, and treatment includes reassurance, advice on syndrome, , and Melkersson Rosen- good oral hygiene, and tongue cleansing.1 ■ thal syndrome.2 It is usually asymptomatic, but if the fi ssures are deep, food may become lodged in them, ■ REFERENCES resulting in tongue infl ammation, burning sensation, 1. Feil ND, Filippi A. Frequency of fi ssured tongue (lingua plicata) as and halitosis.1 a function of age. Swiss Dent J 2016; 126(10):886–897. German. Typically, fi ssures of varying depth extending to pmid:27808348 2. Mangold AR, Torgerson RR, Rogers RS 3rd. Diseases of the tongue. the margin are apparent on the dorsal surface of the Clin Dermatol 2016; 34(4):458–469. tongue. The condition is confi ned to the anterior two- doi:10.1016/j.clindermatol.2016.02.018 thirds of the tongue, which is of ectodermal origin. 3. Kullaa-Mikkonen A, Sorvari T. Lingua fi ssurata: a clinical, stereo- microscopic and histopathological study. Int J Oral Maxillofac Surg Histologically, the , lamina propria, and 1986; 15(5):525–533. pmid:3097176 musculature are all involved in the formation of the 3 ADDRESS: Satvinder Singh Bakshi, MS, DNB, House 1A, Selvam Apart- fi ssures. The deeper fi ssures may lack lliformfi papil- ments, 71 Krishna Nagar Main Road, Krishna Nagar, Pondicherry 605008 lae due to bacterial infl ammation.3 The diagnosis is India; [email protected] doi:10.3949/ccjm.86a.19060

714 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 • NUMBER 11 NOVEMBER 2019

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